理性的临床检查. 这位患者是否患有心肌梗塞?
A A Panju1, B R Hemmelgarn, G H Guyatt
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada. panjuaa@fhs.csu.mcmaster.ca
JAMA
|October 24, 1998
概括
诊断心肌梗塞 (MI) 取决于专注的患者病史,体检和心电图. 关键指标,如ST段的升高增加MI的概率,而正常的心电图和定位疼痛降低它.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 诊断成像 诊断成像 诊断成像
背景情况:
- 急性胸痛需要区分心肌梗塞 (MI) 和其他原因.
- 关于血栓溶解,血管整形和冠状动脉病房入院的临床决定取决于对MI的怀疑.
- 电心电图 (ECG) 变化指导怀疑心脏病发作的治疗决策.
研究的目的:
- 确定帮助诊断心肌梗塞的关键临床和心电图发现.
- 在急性胸痛患者中评估特定历史和体检元素的诊断效用.
主要方法:
- 对临床病史,身体检查结果和急性胸痛患者的心电图结果的审查.
- 对各种临床特征的概率比率 (LRs) 的分析,以确定它们与MI的关联.
- 探索结合临床和心电图数据的计算机衍生算法的潜在作用.
主要成果:
- 新的ST段升高 (LR 5.7-53.9) 和新的Q波 (LR 5.3-24.8) 是强烈的MI指标.
- 双边臂辐射 (LR 7.1),第三心声 (LR 3.2) 和低血压 (LR 3.1) 等特定症状增加了心脏病发作的可能性.
- 降低MI概率的特征包括正常的心电图 (LR 0.1-0.3),多发性疼痛 (LR 0.2),可重现的疼痛 (LR 0.2-0.4),尖的疼痛 (LR 0.3) 和定位疼痛 (LR 0.3).
结论:
- 专注的病史,体检和心电图对于诊断急性胸痛中心脏病发作至关重要.
- 特定的临床特征和心电图发现显著改变了心脏病发作的可能性.
- 结合临床和心电图数据的计算机算法可能会增强心脏病发作风险分层.
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